Health Care and Nine Eleven

Ten years ago, on September 11, 2001, the world changed forever. A committed group of terrorists boarded four planes and committed atrocities so horrific that the American psyche was permanently altered. To remember those images that flashed across television screens that day brings back memories of innocent lives lost, landscapes scarred and blackened in New York, Washington DC, and Shanksville, PA, and the end of business as usual.

A decade has elapsed, and yet within that time frame, a new generation of children have been born who will only know about that day as a moment in time on a calendar, and framed in context to references in history books that focus primarily on the incident from a factual perspective and not address the human element so attached to what has become known as 9/11. But those Americans who were old enough to remember the events of the day know that facts only tell part of the story. Images frozen by still cameras, and video taken by unknown numbers of recorders provide a mind numbing recollection of the horrors lived on that beautiful early fall morning.

The events of that tragic day shaped the Presidency of a new administration. George W. Bush had only been in office a few months and was focused on a domestic agenda. This month, National Geographic Channel presented George W. Bush: The 9/11 Interview, a world premiere documentary that reveals exclusive, first-person insight into the former president's experience following the terrorist attacks of Sept. 11, 2001. In the most in-depth on-camera interview he has ever given on the subject, President Bush recalls what he was thinking and feeling and what drove the real-time, life-or-death decisions he faced in the first minutes, hours and days after the most lethal terrorist attacks ever on U.S. soil. Hear in unprecedented, intimate detail what he grappled with as both commander in chief, and as a man concerned for his family and fellow citizens. George W. Bush: The 9/11 Interview also takes viewers behind the scenes with extensive archival footage and exclusive materials directly from his library that open a new window into his personal experiences during that historic day that changed the face of America, and the world, forever.

But as the morning broke over the East Coast, the aircraft that left with hundreds of passengers bound for planned destinations were rerouted by terrorists who murdered flight crews and took control of what would become flaming missiles of death. Who  of those bleary eyed men and women, struggling to find their seats during the early morning boarding process, would have imagined that within the next few minutes that they would never see home again? Not one of them--lives lost in the human story of life and death.

Who would imagined the night before as they were going to bed on September 10th, that a few hours later the lives of over 3,000 people would be gone, a huge chunk of the Pentagon would be in flames, a smoking crater would be in a field in southwestern Pennsylvania, and the focal point of New York City's skyline, the Twin Towers, would be dust in the wind? America, and the world, was indeed changed forever. Millions of people were affected by the September 11 terrorist attacks — from physical and mental health problems to financial loss. This large and diverse population had different exposures after the collapse of the World Trade Center (WTC), and health effects have varied as a result, according to the NYC Health Commissioner.

What We Know:

Recent studies suggest that post-traumatic stress symptoms are the most common health effect of 9/11. Almost one in five (19%) adults enrolled in the Health Department's WTC Health Registry reported post-traumatic stress symptoms 5 to 6 years after 9/11, roughly 4 times the rate typically found in the general population. Risk factors for probable PTSD included:

--Intense dust cloud exposure or suffering an injury on 9/11.
--Witnessing horror or knowing someone killed or injured on 9/11.
--Little or no social support after 9/11.

Rescue and recovery workers who started rescue work on or soon after 9/11 or who worked at the WTC site for a long time were also more likely to develop PTSD. Workers from non-emergency occupations also suffered high rates of PTSD. People who experienced trauma before or after 9/11, such as losing a job after the attacks, were at increased risk for developing PTSD. Despite widespread evidence of PTSD among all exposed groups, studies have not shown an increase in suicide in the four years after 9/11.

Those exposed to WTC-related dust were more likely to develop respiratory symptoms, sinus problems, asthma or lung problems. One in 10 (10%) Registry enrollees developed new-onset asthma within 6 years of 9/11, 3 times the national rate. New cases were highest during the first 16 months after 9/11. Intense dust cloud exposure on 9/11 increased everyone's risk for developing asthma. The risk was also increased among: rescue, recovery and clean-up workers who arrived early at the WTC site or worked at the WTC site for long periods of time; Lower Manhattan residents who didn't evacuate their homes, and Lower Manhattan residents and office workers who returned to homes or workplaces covered with a thick coating of dust; people who both lived and worked in lower Manhattan after 9/11.

Recent studies show that the steep declines in pulmonary function first detected among firefighters and emergency medical service (EMS) workers within a year of 9/11 have largely persisted even among those who never smoked. It is estimated that four times as many firefighters and twice as many EMS workers had below-normal lung function for their ages six to seven years after 9/11 as they did before the attacks. Among the few active smokers, pulmonary function declines were even greater than for non-smokers. Many WTC-exposed people report heartburn, acid reflux or other gastroesophageal reflux sypmtoms, often with respiratory or mental health symptoms. Since these symptoms are common among the general population, more research is needed to determine if there is a connection between them and WTC exposure.

Several studies have suggested that WTC exposure is associated with sarcoidosis (an inflammation that can affect any organ, but typically affects the lungs) among rescue, recovery and clean-up workers who worked on the debris pile. However, these studies cannot rule out the possibility that increased medical attention and testing may be responsible for the detected increases in sarcoidosis rates among WTC workers. WTC-related mental and physical health conditions often co-exist.

Few studies have addressed the impact of WTC exposure on child and adolescent health, especially physical health, although data from the WTC Health Registry's baseline survey of 3,000 children and adolescents indicate that very young children caught in the dust cloud on 9/11 were at increased risk for developing asthma. In December 2008, the Registry completed a survey of child and adolescent enrollees. The results will help determine to what extent physical and mental health conditions have persisted among children after 9/11, and whether any new symptoms and conditions have emerged. Researchers are actively studying if there is a connection between WTC exposure and other late-emerging illnesses, such as cancer. They also are studying mortality rates in those affected.

As the nation focuses its attention on this tenth anniversary of 9/11, may it's citizens remember what is good about America. May the people of every town, every hamlet, every city, and all across the country recognize that our nation is great, not because of what it owns or how much money or wealth it has, or the quality of the lifestyles it makes available to anyone, but because it is good.  There is always hope that over time, the nation heals from its psychological and emotional scars. The financial recovery has taken care of itself, but there are still lessons to be learned.
 
The spiritual insight into what happened ten years ago has been explored and discussed and rehashed multiple times. Regardless of your denominational bent, the focus of personal relationships and the spiritual impact of a relationship with God rise to the top of any discussion about the events of 9/11. Although that day was a national tragedy and had international repercussions, it was deeply personal for everyone in America. And, for those around the world who watched the events unfold on their TV screens, it became a more personal connection with a nation mourning the loss of its innocence. What did it mean for you? How did you deal with the loss, the shock, the horror, the sadness, the fallout from images burned into your brain as you watched countless reruns of people dying? Have you processed those and buried them over time, or do those pictures spur memories that cause you to stand still and remember?
 
As America, and you as an individual, pauses this Sunday to reflect on the last ten years and the souls that went into eternity on 9/11, 2001, remember what's important in life. Stay close to family and love them unconditionally. Make lots of friends and be a friend to them. Love what you do, and don't stress out over the unimportant. Reflect on the majesty of the universe and of nature, and know that the Creator of all knows you by name. Pray for peace. No one is guaranteed more than a day at a time. Life is short, like a vapor. Take steps to make sure of your eternal destiny, and look to salvation in a loving God who keeps His faithfulness to those who call him by name. Security is not in buildings, or investments, or houses and land, or in any other thing. Those tangible assets provide a way to live, but they don't provide peace or comfort beyond the grave. Be ready. This weekend you should set time aside to meditate on your relationships and what you can do to increase your faith--in America, in your family and friends, and in God.
 
Until next time.